Provider Demographics
NPI:1285256297
Name:SNOW, AMANDA MAE (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:SNOW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MAE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3314 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-2256
Mailing Address - Country:US
Mailing Address - Phone:859-866-6259
Mailing Address - Fax:
Practice Address - Street 1:4444 DIXIE HWY STE 1
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1896
Practice Address - Country:US
Practice Address - Phone:859-740-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty